Objectives To describe the evolution of interstitial lung disease (ILD) in RA patients treated with disease modifying antirheumatic drugs (DMARDs) for 1 year in real clinical practice conditions.
Methods Design: Prospective observational case-series. Patients: Patients with RA (ACR/EULAR 2010 criteria) and ILD (American Thoracic Society/European Respiratory criteria) from two centres (Regional Hospital of Málaga and Valme Hospital of Sevilla) were included. Protocol: All patients with RA and ILD who visited outpatient clinic from January to December 2015. They were reviewed according to a predetermined protocol for systematic data collection. Resolution Computed Tomography (HRCT),Pulmonary function test (PFT) and echocardiogram were requested for all patients.This visit was marked as v0 (index date). At 12 months (v12) the joint assessment (DAS28), echocardiogram, PTF and HRCT were again evaluated. HRCT's were assessed by the same radiologist with expertise in chest radiology. Outcomes: At v12:(1)improvement (ie improvement in FVC≥10% or DLCO≥15% and no radiological progression),(2)non-progression (stabilization or improvement in FVC≤10% or DLCO<15% and no radiological progression),(3)progression (worsening of FVC>10% or DLCO>15% and radiological progression), or (4) death due to ILD. Variables: Description of ILD type (Nonspecific interstitial pneumonia/Usual interstitial pneumonia) and lung function by PTF, HRCT.Presence of PTH by echocardiogram and dyspnoea.Collection of adverse events. Statistical analysis: Descriptive analysis and Wilcoxon or T test between the v0 and v12. One factor ANOVA between sDMARD,bDMARD and combination therapy groups.
Results The main characteristics at V0 of the patients (n=22) are shown in the table. Seven patients (31.8%) received a sDMARDs with a bDMARDs; 12 patients (54.5%) in monotherapy with sDMARD, with MTX being the most frequent (34.7%); 3 (13.6%) in monotherapy with bDMARDs (Table 1). Three patients (13.6%) had improvement (1 with MTX, 1 with RTX and 1 with HCX + RTX), 15 patients (68.2%) remained stable (4 with MTX, 3 with LFN, 1 with HCQ, 1 AZA, 1 ABT, 1ABT + SSZ, 2 MTX + ETN, 1 HCQ + RTX, and 1 HCQ + ADA);and 3 (13.0%) got worse of ILD (1 with MTX developed unknown lung mass, 1 with LFN and 1 with LFN + IFX). One patient died during follow-up due to respiratory infection (under treatment with RTX). No patient developed PPH. We did not find significant differences between v0 DAS28 and at 12 months (2.55 [0.75] vs 2.42 [1.22], p=0.567) or in HAQ 1.15 [0.93] vs 1.25 [0.78], p=0.450). There were no significant differences in PTF, HRCT or DAS28 at v12 between sDMARD, bDMARD and combination therapy groups. Four patients (18.2%) had adverse effects: 2 respiratory infections, 1 oral herpes simplex and 1 tooth infection.
Conclusions Most patients with RA and ILD who are receiving treatment with DMARD (82%)remained stable or improved after at least 1 year of both synthetic and biological DMARD treatment. However, a significant percentage of patients had an adverse outcome. More prospective studies with a greater number of patients are necessary to identify the influence of DMARDs in this evolution.
Disclosure of Interest None declared